Basic Information
Provider Information | |||||||||
NPI: | 1750953808 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BARAKAH TWO THOUSAND DRUGS LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | FARMACIA CARIDAD | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 4218 | ||||||||
Address2: |   | ||||||||
City: | BAYAMON | ||||||||
State: | PR | ||||||||
PostalCode: | 009581218 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877877733 | ||||||||
FaxNumber: | 7872690022 | ||||||||
Practice Location | |||||||||
Address1: | BOULEVARD MEDIA LUNA 5720 | ||||||||
Address2: | BARRIO ANTON | ||||||||
City: | CAROLINA | ||||||||
State: | PR | ||||||||
PostalCode: | 00983 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877877733 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/16/2021 | ||||||||
LastUpdateDate: | 08/31/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | YASSIN | ||||||||
AuthorizedOfficialFirstName: | MANNA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF INFORMATION OFFICER | ||||||||
AuthorizedOfficialTelephone: | 7875471991 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | BARAKAH TWO THOUSAND DRUGS LLC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/31/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X |   |   | N |   | Suppliers | Pharmacy |   | 3336C0003X |   |   | Y |   | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.